Objective: To study the relationship between serum HBV pgRNA and antigen status in patients with chronic hepatitis B treated with long-term nucleotide analogues, and to elucidate the reason and possible mechanism of high relapse rate in antiviral therapy of nucleotide analogues in chronic hepatitis B. Methods: 94 patients with chronic hepatitis B who had been treated with long-term antiviral therapy with nucleotide analogues (more than 2 years) were divided into 5 groups according to their HBeAg and HBsAg levels: e antigen positive group(group1), e antigen negative and HBsAg > 1 500 IU/L group(group2), e antigen negative and 100 IU/L< HBsAg < 1 500 IU/L group(group3), e antigen negative and HBsAg < 100 IU/L group(group4), e antigen negative and HBsAg negative group(group5). The level and detection rate of HBVpgRNA in different antigen states groups were analyzed and compared. In addition, in order to exclude the influence of other factors on the results of this study. The study was divided into groups according to age, gender and treatment time. Results: The detection rate of HBVpgRNA was 95.0% in patients with e antigen positive, while 43.2% in patients with e antigen seroconversion, which was significantly lower than that in patients with e antigen positive (P < 0.05). The detection rate of serum HBVpgRNA was 95.0% in e antigen positive group, 75.0% in group 2, 65.0% in e antigen negative with group 3, 15.0% in group 4 and 0% in group 5. Among them, group 1, group 2 and group 3 was significantly higher than that in group 4 and group 5. There was significant difference between the two groups (P < 0.05). However, there was no difference in the positive rate of serum HBV pgRNA among group 1, group 2 and group 3 (P > 0.05). Similarly, there was no difference in the positive rate of serum HBV pgRNA between group 4 and group 5 (P > 0.05). Moreover, the detection rate of serum HBV pgRNA was not correlated with age, gender and treatment time of nucleotide analogues (P > 0.05). Conclusion: There is a significant correlation between the serological antigen status and the presence of HBV pgRNA in chronic hepatitis B after long-term treatment of nucleotide analogues. The persistence of HBV pgRNA is closely related to the low seroconversion rate of e antigen and the high level of HBsAg. HBV pgRNA can be used as one of the biomarkers to judge the transcription activity and replication status of HBV cccDNA in liver.

目的 研究血浆置换联合胆红素吸附治疗慢加急性乙肝肝衰竭急性肾损伤的疗效.方法 选择慢加急性乙肝肝衰竭伴有急性肾损伤的患者35例,同时选择慢加急性肝衰竭合并肝肾综合征患者16例.在常规内科药物治疗的基础上,采用血浆置换联合胆红素吸附治疗,收集入院时、人工肝治疗前、人工肝治疗后、治疗后第7d以及出院(或死亡)等时间点的肝肾功能、血常规及凝血酶原时间等指标,并使用改良中国人MDRD-eGFR计算简化公式计算上述时间点的eGFR,分析比较上述指标的变化情况,同时分析比较两组患者的的疗效和病死率.结果 急性肾损伤组患者经过人工肝治疗,其血清肌酐水平明显降低,eGFR水平明显改善,治疗前后比较,差异显著(P均<0.05).且肌酐降低和肾功能改善持续存在直至出院;而肝肾综合征组患者,虽然经过人工肝治疗后,其血清肌酐水平及eGFR水平均可改善,治疗前后存在明显差异(P<0.05),但是改善仅短暂存在,随着病程进展,血清肌酐持续升高,肾功能持续恶化.两组患者的病死率相比较存在极其显著差异(P<0.01),而且急性肾损伤组患者在人工肝治疗后仍然进展为肝肾综合征的比例仅有22.85％.结论 血浆置换联合胆红素吸附人工肝治疗慢加急性乙肝肝衰竭急性肾损伤可以降低患者血清肌酐水平,改善肾功能,减少进展至肝肾综合征的风险,由此降低慢加急性肝衰竭急性肾损伤患者的病死率.可以作为一项针对慢加急性肝衰竭急性肾损伤患者的有效治疗方法.

目的 比较血浆置换联合胆红素吸附与单纯血浆置换治疗慢加急性肝衰竭的疗效及安全性.探讨既节省血浆用量,又有效安全的治疗方法.方法 选择2016年期间我科收治的慢加急性肝衰竭患者62例.按照治疗方案不同分为:A组(血浆置换联合胆红素吸附)30例,(其中男26例,女4例,平均年龄(45±12)岁;B组(单纯血浆置换)32例,(其中男28例,女4例,平均年龄(42±13)岁).所有患者均在常规内科护肝退黄及支持治疗的基础上给予人工肝治疗.血浆置换联合胆红素吸附治疗的血浆用量为1500ml/次,单纯血浆置换治疗的血浆用量为3000ml/次.分析比较两组患者治疗后其肝功能、凝血酶原时间及临床症状等改善的情况,同时观察不同治疗方法对患者电解质、血常规的影响,重点观察并比较两种不同的治疗方法在治疗过程中不良反应,尤其是严重不良反应发生的情况以及对患者病情的影响.结果 血浆置换联合胆红素吸附治疗慢加急性肝衰竭,可明显改善患者ALT、TBIL、DBIL、凝血酶原时间及临床症状等(P<0.05),与单纯血浆置换治疗对上述指标改善相比较无明显差异.血浆置换联合胆红素吸附治疗后对患者血电解质、白细胞、红细胞及血小板的影响较小,与单纯血浆置换治疗后对上述指标的影响相比较无显著差异(P>0.05).在治疗过程中过敏反应发生及严重程度上,血浆置换联合胆红素吸附治疗过程中过敏反应的发生以及严重程度均明显较单纯血浆置换治疗更低(P<0.05).此外,血浆置换联合胆红素吸附血浆用量仅需:1500ml/次,明显少于单纯血浆置换血浆用量:3000ml/次.大大减少了血浆的用量,较好地解决了目前血浆供应短缺的难题.结论 血浆置换联合胆红素吸附是目前临床上治疗慢加急性肝衰竭的一个即节省血浆,又有效且安全的、值得推广的治疗方法.

目的 探索G蛋白信号调节因子2(RGS2)蛋白在肺腺癌中的表达及其临床意义,为探索肺腺癌患者治疗靶点和预后标志物提供科学依据.方法 收集3例肺腺癌患者肿瘤组织和匹配癌旁组织,RT-PCR及Western blot分析RGS2表达的差异.利用在线TCGA数据库资料分析肺腺癌和匹配的癌旁组织中RGS2 mRNA表达的差异.同时收集72例肺腺癌患者的石蜡包埋的肿瘤组织标本及临床资料,免疫组织化学染色检测肺癌组织中RGS2蛋白的表达,分析其表达与患者临床特征包括预后的关系.结果 在3例肺腺癌中,RGS2 mRNA和蛋白表达均低于其匹配的癌旁组织中表达.在TCGA数据库53例肺腺癌和匹配的癌旁组织中,RGS2 mRNA在肺腺癌组织中表达明显下调(P<0.001).在72例肺腺癌病理标本中,RGS2蛋白低表达或阴性表达48例(66.7%),高表达者24例(33.3%).GRS2主要表达于胞浆和胞膜上.RGS2蛋白高表达的患者,其5年生存率明显优于低表达的患者(P<0.05),且RGS2蛋白低表达是肺腺癌患者预后不良的重要危险因素.结论 RGS2是肺腺癌的抑癌基因,可作为肺腺癌患者的治疗靶点和预后预测的分子标志物.

AIM: To explore the clinical significance of Krüpple-like factor 15 (KLF15) protein expression in the patients with lung adenocarcinoma for exploring the therapeutic and prognositic biomarkers of lung cancer.ME-THODS: Four cases of lung adenocarcinoma tissues and matched adjacent tissues were collected from our hospital, and the expression of KLF15 protein in these tissues was analyzed by Western blot.At the same time, 72 cases of archived paraffin-embedded samples and clinical data of the patients with lung adenocarcinoma were also collected.The KLF15 protein expression in the archived paraffin-embedded lung adenocarcinoma samples was detected by immunohistochemical staining.The correlations between KLF15 protein expression and clinical characteristics of the patients including prognosis were also analyzed.In addition, the KLF15 protein was up-regulated in A549 cells, and then the effects of KLF15 protein on the viability of the cells were measured by CCK-8 assay.RESULTS: The protein expression of KLF15 in the 4 cases of lung adenocarcinoma tissues was significantly lower than that in matched paracancerous tissues.Fifty-three cases of lung adenocarcinoma specimens showed low expression or no expression of KLF15 protein in total 72 cases (73.6%).The 5-year survival rate of the patients with high expression of KLF15 protein in their specimens was higher than that of the patients with the low expression of KLF15 protein (P<0.01), and the expression of KLF15 protein was significantly correlated with the pathological staging (P<0.01) and T stage (P<0.01) of the patients with lung adenocarcinoma.Furthermore, the low expression of KLF15 protein was an important poor prognostic indicator of the patients.Up-regulation of KLF15 protein in the A549 cells significantly inhibited the growth of the cells.CONCLUSION: KLF15 inhibits the growth of lung adenocarcinoma cells.It could be used as a therapeutic target and a prognostic biomarker for the patients with lung adenocarcinoma.

目的：探讨慢性阻塞性肺疾病（ COPD）临床表型的分型方法及表型特征。方法收集231例COPD患者的临床变量，采用主成分因子分析和聚类分析法，确定COPD的临床表型，总结各表型特征。结果主成分因子分析方法从231例COPD患者的16个临床变量中提取出5个公因子，以公因子为聚类变量，两步聚类法分成5个聚类，结合临床，总结出5个COPD表型，分别是老年人重度、老年人中度、年轻老人轻度、年轻老人中度、年轻老人重度。其中老年人中度表型，不吸烟、70岁以上才出现症状，但合并症较多，急性加重频率高；而年轻老人重度表型，小于55岁起病，大量吸烟，肺功能损害重，频发急性加重，营养差。结论主成分因子分析联合聚类分析法可用于中国COPD临床表型分析。初步总结出5个COPD临床表型，其中老年人中度和年轻老人重度表型值得临床重视。

本文将当代工笔花鸟画与南宋工笔花鸟画进行了比较分析，找出当代工笔花鸟画对南宋工笔花鸟画有哪些继承与发展。

目的:系统评价利奈唑胺对比糖肽类抗菌药物治疗耐甲氧西林金黄色葡萄球菌(MRSA)相关性院内获得性肺炎的疗效和安全性.方法:计算机检索Medline、EMBase、OVID、中国生物医学文献数据库、中国期刊全文数据库、维普及万方数据库,查找利奈唑胺对比糖肽类抗菌药物治疗MRSA相关性院内获得性肺炎的随机对照试验(RCT).对符合条件的RCT进行资料提取和质量评价后,采用Rev Man 5.1统计软件进行Meta分析.结果:共纳入8项RCT,合计l 966例患者.Meta分析结果显示,利奈唑胺治疗MRSA相关性院内获得性肺炎的临床治愈率[RR=1.10,95％CI(1.01,1.20),P=0.03]、微生物清除率[RR=l,14,95％CI(1.03,1.27),P=0.01]均高于糖肽类抗菌药物;而两者的病死率[RR=0.86,95％CI(0.68,1.08),P=0∶20]和不良反应发生率[RR=1.05,95％CI(0.94,1.16),P=0.41]比较差异无统计学意义.结论:利奈唑胺较糖肽类抗菌药物治疗MRSA相关性院内获得性肺炎可以提高患者的临床治愈率和微生物清除率,但是不能改善患者病死率及不良反应发生率.限于研究的设计及报告质量,该结论仍有进一步评价的必要.

近年来人工肝治疗已成为重症肝炎患者的重要治疗手段，分子吸附再循环系统（MARS）是一种新的人工肝脏支持系统，是目前模拟肝脏解毒功能中最先进的人造生物肝脏支持系统［1］，能减轻肝细胞坏死，改善血流动力学，预防和治疗肝性脑病及肝肾综合征，是重症肝炎安全、有效的治疗方法［2］。重症肝炎患者肝脏合成功能差，凝血酶原时间（PT）明显延长，血小板也明显减少。而MARS人工肝治疗术中采用体外循环6～8 h，全程肝素化治疗，出血是术中最常见并发症之一。大量出血常使治疗终止，严重影响治疗效果，导致手术失败，甚至危及患者生命。南昌大学第一附属医院感染科于2012年11月15日收治1例重症肝炎合并肝性脑病患者带入Ⅱ度压疮，行MARS人工肝治疗术中压疮持续出血，经人工肝治疗护士精心观察、护理干预后顺利完成治疗，术后病情好转、压疮愈合出院。现将护理情况报告如下。

Objective To evaluate the reliability,validity and responsiveness of the Chinese version of cough-specific quality-of-life questionnaire(CQLQ).Methods A total of 86 patients coming to our hospital because of cough were evaluated using CQLQ and its reliability,validity and responsiveness were analyzed according to the results.Results The Cronbach's α coefficient and the 24 h test-retest reliability coefficient of the CQLQ were 0.935 and 0.931 respectively.The correlation coefficient between the scores of the four aspects(including physical complaints,psychosocial issues,functional abilities,and extreme physical complaints) and the total questionnaire score was high(> 0.8),but the coefficients of emotional well-being and personal safety fears were 0.536 and 0.540 respectively.Six common factors were extracted by the factor analysis which defined 66.603% of the full variation rates.The total score of questionnaire was up to 0.99 before and after treatment.Conclusion CQLQ has good reliability and validity,which can better distinguish treatment effects.

Objective To explore the effective strategy of passive smoking control in three hospitals in Guangzhou city and evaluate its effect in order to provide the basis to formulate relevant policies in hospital. Methods 5 smoking control strategies were implemented in three hospitals in Guangzhou city which includes enacted non-smoking public facilities, whole society mobilization, creating smoking-free hospitals, smoking-free homes and smoking-free community, and the establishing social network for tobacco control. An analysis was conducted, and the comparison was made before and after the intervention thru November, 2011 to November, 2012. Three hospitals were investigated with field observation method on their status of tobacco smoking control by surveying 1500 people from each of the three hospitals. Results An improvement was observed after the intervention,P<0.05,as well as the knowledge of passive smoking hazards,P<0.05. Conclusion The five strategies for passive smoking controls are considered being effective in enhancing people’s awareness on smoking hazards and reducing exposure to passive smoking.

目的探讨霉菌性脑膜炎患者早期使用PICC置管的可行性和必要性。方法将60例经静脉给药治疗霉菌性脑膜炎患者随机分成试验组(31例)和对照组(29)例。试验组在早期(3d内)行PICC置管,对照组在治疗后期(30d后)行PICC置管。结果试验组一次性置管的成功率为96.8%,置管留置时间为(51.8±5.2)d,而对照组一次性置管成功率为62.1%,置管留置时间为(14.6±2.5)d,2组相比差异均有统计学意义(P<0.05)。结论霉菌性脑膜炎治疗早期行PICC置管较后期一次性置管成功率高,并发症低,置管留置时间长,值得临床推广。

目的 观察哮喘小鼠肺组织TRPM8与TRPA1 mRNA的表达.方法 SPF级雌性Balb/c小鼠16只,随机分为哮喘组和对照组,每组8只.哮喘组应用卵蛋白(OVA)建立哮喘小鼠模型,末次激发后留取肺组织,采用荧光实时定量 RT-PCR 技术检测支气管肺组织中TRPM8与TRPA1的mRNA表达水平.结果 哮喘组肺组织中TRPM8与TRPA1 mRNA水平分别为(0.619 1±0.213 1)和(0.272 2±0.167 1),明显高于对照组(0.347 1±0.221 1和0.107 9±0.041 5),差异有统计学意义(P<0.05).结论 哮喘小鼠肺组织TRPM8与TRPA1 mRNA的表达上调,可能是冷刺激诱发哮喘发作的分子机制.

Objective To investigate the expression stability of 12 common housekeeping genes(HKGs) in jugular-nodose ganglion complex(JNC) from control and asthmatic mice.Methods Female BALB/c mice were randomly divided into control group and asthma group.Expression levels of 12 candidate HKGs,CYC1,UBC,RPL13,YWHAZ,18srRNA,B2M,SDHA,ATP5B,CANX,ACTB,EIF4A2 and GAPDH,were measured by quantitative real-time PCR in JNCs from 5 normal mice and 5 asthmatic mice.Gene expression stability was subsequently determined using geNorm and Normfinder applets.Results GAPDH,18srRNA,CANX,ACTB and EIF4A2 were relative stably expressed.However,the expression levels of CYC1,UBC and RPL13 were significantly different between the two groups.GAPDH was ranked the most stable by geNorm and Normfinder.Conclusions The results suggest that GAPDH is the most suitable housekeeping gene analyzed for expression studies in JNCs from normal and asthmatic mice,and provide the evidence of the importance of validating housekeeping genes for different experimental model.

肺血管内皮细胞损伤及继而引起的血管活性因子失衡是慢性阻塞性肺病(COPD)造成肺动脉高压、并最终发展为肺心病的重要发病环节.

Objective To explore the role of the sensory neuropeptide in the chronic cough induced by postnasal drip syndrome(PNDs).Methods Patients of PNDs with and without chronic cough who came to the First Affiliated Hospital of Ji Nan University between Mar.2004 and Sep.2005 were enrolled and induced sputum by hypertonic saline aerosol inhalation was performed.Twenty-three cases of PNDs with chronic cough and 16 cases of PNDs without chronic cough were collected.Substance P(SP)and calcitonin gene-related peptide(CGRP)in the supernatant of the induced sputum were measured by radioimmunoassay.Results SP and CGRP in the supernatant of the induced sputum were significantly higher in the patients with chronic cough induced by PNDs[SP(345.14±72.58)mg/L,CGRP(573.78±210.96)mg/L]as compared with those normal subjects[SP(168.14±56.97)mg/L,CGRP(227.69±70.84)mg/L,P<0.01]and the PNDs[SP(270.98±36.25)mg/L,CGRP(362.13±73.67)mg/L,P<0.05].The concentration of SP reduced to(261.09±37.04)mg/L and CGRP to(335.73±55.07)mg/L after therapy and was significantly lower compared with before theray,but it was still significantly higher than normal subjects.Conclusion The sensory neuropeptide may participate in the onset process of PNDs and propably it is the mechanism of chronic cough induced by PNDs.

目的研究左氧氟沙星治疗老年人医院内下呼吸道感染的临床疗效。方法采用随机开放对照的方法,观察组用左氧氟沙星0.3 g,1次/d静脉滴注,对照组用头孢呋辛1.5 g,2次/d静脉滴注,两组疗程均7~14d。结果观察组痊愈率、有效率、细菌清除率分别为87.9%、90.9%、94.7%,对照组痊愈率、有效率、细菌清除率分别为80%、96.7%、88.9%,两组不良反应发生率分别为6.06%、3.33%,两组比较差异无显著性(P>0.05)。结论左氧氟沙星治疗老年人下呼吸道感染疗效好、安全性高。

目的探讨哮喘完全控制时气道炎症状态.方法哮喘患者36例,均按获得最佳哮喘控制研究的方法进行治疗,并测定肺功能和诱导痰细胞学分类.结果治疗后完全控制组肺功能改善更加明显,与非完全控制组的差异具有显著性(P《0.05);诱导痰嗜酸性粒细胞明显下降,与治疗前的差异具有显著性(P《0.05),但2组间差异无显著性.结论哮喘达到完全控制时,肺功能改善明显,但气道炎症并没有得到完全控制,与非完全控制者类似,仍然需要继续治疗.

目的:检测Fc epsilon RI-beta三个突变位点I181L,V183L和E237G在中国南方汉族人群中的存在和频率分布;判断这些突变与哮喘及特应症的相关性.方法:利用扩增阻滞突变系统聚合酶链技术(ARMS-PCR)对60例哮喘患者Fc epsilon RI-beta基因编码181,183和237的三个氨基酸位点进行分析和检测,并与65例正常人进行对照.结果:在哮喘组中检测到1例I181L杂合子,被检人群中没有发现V183L突变.Glu237/Cly237在哮喘人群中的频率是18.3%,E237G突变基因频率为9.2%;Glu237/Cly237在特应性哮喘人群中的频率是22.6%E237G突变的基因频率为11.3%,Glu237/Gly237在正常对照人群中的频率是6.2%E237G突变的基因频率为3.1%.结论:在中国南方汉族人群中存在E237G突变.不存在V183L突变或突变率很低.E237G突变与哮喘有相关性(P＜0.05 OR=3.18);E237G突变与特应症有相关性(P＜0.025 OR=4.00),I181L突变的存在不确定.

目的探讨晚期支气管肺癌引起呼吸困难的治疗手段.方法采用KTP/YAG双波长激光经纤维支气管镜治疗及配合气管支架治疗晚期肺癌4例.结果每例经2～3次激光姑息治疗,患者的咳嗽、气急等梗阻症状显著缓解,肿瘤不同程度缩小,支气管通畅,管腔扩大.未发生窒息、气胸、出血等并发症.结论该方法作为一种姑息疗法,能够迅速缓解晚期肺癌患者气道阻塞,改善通气,提高生存质量.